MEDICARE: OHIO VALLEY RESIDENTIAL SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency	251V00000X	OH
2	347C00000X	Private Vehicle	347C00000X	OH
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	320900000X	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053489153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO VALLEY RESIDENTIAL SERVICES INC

Provider Business Mailing Address
First Line	:	2261 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2821
Country	:	US
Telephone Number	:	513-281-6800
Fax Number	:	513-487-4787

Provider Business Practice Location Address
First Line	:	2261 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2821
Country	:	US
Telephone Number	:	513-281-6800
Fax Number	:	513-487-4787

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MICHAEL ANGELO DEFRANCESCO
Credential	:	MA
Telephone Number	:	513-281-6800

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	06/17/2008

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